Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best-practice Indigenous maternity service in an urban setting

Abstract

Developing high-quality and culturally responsive maternal and infant health services is a critical part of 'closing the gap' in health disparities between Aboriginal and Torres Strait Islander people and other Australians. The National Maternity Services Plan led work that describes and recommends Birthing on Country best-practice maternity care adaptable from urban to very remote settings, yet few examples exist in Australia. This paper demonstrates Birthing on Country principles can be applied in the urban setting, presenting our experience establishing and developing a Birthing on Country partnership service model in Brisbane, Australia. An initial World Café workshop effectively engaged stakeholders, consumers and community members in service planning, resulting in a multiagency partnership program between a large inner city hospital and two local Aboriginal Community-Controlled Health Services (ACCHS). The Birthing in Our Community program includes: 24/7 midwifery care in pregnancy to six weeks postnatal by a named midwife, supported by Indigenous health workers and a team coordinator; partnership with the ACCHS; oversight from a steering committee, including Indigenous governance; clinical and cultural supervision; monthly cultural education days; and support for Indigenous student midwives through cadetships and placement within the partnership. Three years in, the partnership program is proving successful with clients, as well as showing early signs of improved maternal and infant health outcomes.

Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review

“…This would help to determine the effectiveness of these interventions. It seems that bodies of evidence are developing for interventions with specific populations in some countries or world regions, notably Australia and parts of Latin America (Wasserman et al 2007; Castro 2012; Kildea and Van Wagner 2012; Jongen et al 2014). Yet, intervention studies from many other countries that have documented the impact of cultural factors on use of care are disconnected.…”

“…This is perhaps unsurprising given the challenging process of collating papers on interventions that have addressed cultural factors in maternity care services (Coast et al 2014). This review, as well as other recent reviews for interventions in specific contexts (Kildea and Van Wagner 2012; Jongen et al 2014), provides a starting point for such efforts. Researchers should be clear on the research question, determine an optimal study design, seek to define the intervention and its context carefully, standardize outcome measurements while allowing local contextualization, and document important process issues (WHO 2015b).…”

“…Third, it is possible that we missed some relevant literature, most likely grey or non-English-language literature, despite extensive efforts to uncover such evidence through expert recommendations. Literature reviews of interventions in Australia (Kildea and Van Wagner 2012) indicate that evaluations of such interventions may sometimes be documented only within in-service or programme reports that are less likely to be uncovered by database searches or even expert suggestions. Our global focus meant that we were unable to follow-up on such avenues in each country to the extent possible in more context-focused reviews, such as Kildea et al (2012).…”

“…Minority groups across world regions frequently have poorer maternal and newborn health outcomes and may be less likely than other populations to use skilled maternity care services (Wasserman et al 2007; Harris et al 2010; Kildea and Van Wagner 2012). Studies have shown that cultural factors can affect uptake of maternity care services, and addressing them has been recognized as an important step in increasing the use of services (Thaddeus and Maine 1994; WHO 2003; UNFPA 2005; Camacho et al 2006; Gabrysch and Campbell 2009; Castro 2012; Bohren et al 2014).…”

“…As far as the research team is aware, this systematic review is the first to address this research question. Other review articles that address-related questions informed the present review as relevant background literature (Anderson et al 2003; Wasserman et al 2007; Kildea and Van Wagner 2012; Jongen et al 2014). …”